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n233 final > QUIZ- postop > Flashcards

QUIZ- postop Flashcards

1
Q

PACU=

A

post anesthetic care unit

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2
Q

PAR=

A

post anesthesia recovery. same as pacu

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3
Q

POD0

A

post op day 0, day of surgery

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4
Q

PONV

A

post op nausea vomiting

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5
Q

GA

A

general anesthesia

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6
Q

d/c

A

discharge or discontinued

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7
Q

lap

A

laparoscopic

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8
Q

open

A

incision

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9
Q

nurses role in the recovery room?

A
  • more freq assessments in initial post op period (ex q15 min in pacu)
  • airway management, preventing hypoxemia, hypercapnia
  • cardiovascular stabilization
  • managing acute pain
  • controlling PONV
  • relieving anxiety
  • preping for transfer to surgical unit
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10
Q

nurses role in surgical unit?

A

help pt recover from anesthesia

  • assess vitals
  • monitor resp, cardio, neurologic status
  • monitor for complications,
  • pain management
  • promoting self care
  • prep for discharge
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11
Q

how do we know what to expect as a “normal finding””?

A

-pts baseline!!! what is expected

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12
Q

post op complications: resp

A

atelectasis, pneumonia, PE aspiration

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13
Q

cardio post op complications

A

shock, thrombophlebitis

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14
Q

neurologic post op complications

A

delirium, shock

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15
Q

skin/wound post op complications

A

breakdown, infection, dehiscience, evisceration, delayed healing, hemorrhag, hematoma

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16
Q

GI post op complications?

A

constipation, parlytic ileus, bowel obstruction

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17
Q

urinary post op complications?

A

acute urine retention, urinary tract infection

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18
Q

functional post op complication?

A

weakness, fatigue, functional decline

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19
Q

thromboembolic complication?

A

DVT, PE

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20
Q

priority problems/nursing diagnosis

A 
N&V
ineffective airway clearance 
pruritus 
urinary retention
risk for activity intolerance
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21
Q

enhanced recovery after surgery…

A
  • multimodal, multidisciplinary perioperative pathways
  • designed to shorten recovery and decrease complications
  • principles incorporated into clinical pathways and order sets
  • preop: education, smoking and alcohol cessation, nutritional optimization
    intraop: short acting anesthetics, minimize IV fluids, PONV prophylaxis
    postop: early mobilization, advance diet quickly, supplemental nutrition, change to oral analgesic
  • patient involved and patient centered
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22
Q

Post op orders and pathways?

A

are specific to surgery or general

  • clear goals and direction
  • highlights interventions
  • interdisciplinary team document on same pathway
  • if someone has “fallen off” the pathway—> not meeting expected outcomes
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23
Q

post-op pain control principles?

A

pain is what the patient says it is
may be opioid sensitive or tolerant
-consistent admin better than PRN
-assess before/after interventions and document
-anxiety and fear increase pain experience
-use pain control adjuncts
-monitor for side effects

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24
Q

what is patient controlled analgesia?

A

effective way to control pain

  • increases patient feeling of control
  • pt must be cognitively and physically able to use it
  • can be through IV or epidural
  • only pt can push button!!
  • there is a “lock out” period between doses
  • teaching essential
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25
Q

IV PCA assessments?

A

vitals, pain, sedation scale, resp function, NV, pruritus, insertion site, bladder function, bowel function

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26
Q

patient controlled epidural analgesia?

A
  • same assessments as with IV PCA PLUS
  • –> motor function (bromage scale)
  • —>sensory deficit assessment (ice test)
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27
Q

with post-op ambulation watch for

A

orthostatic hypotension

—> requires pain management without over sedation

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28
Q

postop nutrition and hydration?

A
  • need adequate nutrition
  • protein, vit A and C, zinc
  • IV solution
  • Fluid balance and requirements
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29
Q

pediatric considerations?

A
  • involve child as much as possible
  • provide distraction
  • allow them to express their feelings
  • provide positive enforcement
  • incorporate play
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30
Q

mini med card for ranitidine?

A

gastric acid reduce (histamine h2 antagonist)
-given PREOP to pt at risk of aspiration (like sodium citrate)
inhibits gastric acid secretion and gastric volume
slower onset than sodium citrate
-monitor for CNS changes, can cause confusion

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31
Q

IV general anesthetics: propofol and midazolam

A

both IV general anesthetics
advantage of P: rapid onset, rarely malignant hyperthermia
advantage of M: no pain on injection, can produce amnesia, short acting

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32
Q

mini med card on propofol…

A

IV general anesthetic

  • induction and maintanence of GA, sedation
  • rapid onset, rarely any malignant hyperthermia
  • can be painful when injected, decreases CO and resp drive
  • monitor for HTN and resp depression, elimination half life is short (34-64 mins)
33
Q

mini med card on midazolam…

A

iv general anesthetic, benzodiazepine

  • to induce anesthesia often w other meds, preop sedation, decrease anxiety
  • no pain on injection, can produce amnesia
  • slower induction
  • monitor VS and level of sedation
  • can cause resp depression, N/V
34
Q

nursing management after surgery (first 24 hours)

A

recover from effects of anesthesia, physiologic status, monitoring for complications, managing pain, implementing measures to achieve long-range goals of independence, discharge to home, and full recovery

35
Q

primary concerns in initial hours after admission to clinical unit?

A

adequate ventilation, hemodynamic stability, incisional pain, surgical site integrity, n&v, neurologic status, spontaneous voiding

36
Q

pulse, BP, RR recorded…?

A

15 mins for first hours, 30 mins for next 2 hours, and then less freq if remaining stable

37
Q

focus shifts from intense physiologic management and symptomatic relief of adverse effects of anesthesia to…

A

regulating independence and prep for discharge

38
Q

things to expect in post op that show they are progressing?

A

begin breathing and leg exercises as appropriate, dangling legs over edge of bed, ambulating a bit, tolerating light meal, IV fluid discontinued

39
Q

shallow and rapid respirations may be caused by

A

pain, constricting dressings, gastric dilation, abdominal distension or obesity

40
Q

flash pulmonary edema?

A

possible complication—> occurs when protein and fluid accum in alveoli
-signs and symptoms= agitation, tachycardia, decrease pulse oximtery, pink sputum

41
Q

major goals of post op

A

resp function optimal and CV function, relief of pain, increased activity tolerance, unimpaired wound healing, maintenance of body temp, maintenance of nutritional balance

42
Q

resp complications?

A

atelectasis: risk for pt not moving or doing deep breathing: decreased breath sounds, crackles, cough
pneumonia: chills and fever, tachycardia
hypostatic pulm congestion may develop

43
Q

hyoxemia: subacute vs episodic

A

subacute: constant low level O2 when breathing appears normal
episodic: suddenly, pt at risk for cerebral dysfunction, MI, cardiac arrest

44
Q

2 requirements to use a PCA:

A

-understanding of need to self-dose
and
-physical ability to self-dose

45
Q

pros of a PCA?

A

promotes pt participation in care, eliminates delayed administration of analgesics, maintains a therapeutic drug level, enables pt to move turn cough and take deep breaths

46
Q

what is intrapleural anesthesia

A
  • provides sensory anasthesia without affecting motor function to intercostal muscles
  • allows more effective coughing and deep breathing
47
Q

who is coughing contraindicated in

A

head injuries or intracranial surgery or eye surgery or plastic surgery

48
Q

if pt has catheter report…

A

less than 40 ml /hr

49
Q

if pt voiding report..

A

output of less than 240ml per 8 hr

50
Q

promoting cardiac output…

A

monitor ins and outs, hydration, mobility, monitor labs (hematocrit, hemoglobin) kook for altered tissue perfusion

51
Q

benefits of encouraging activity

A

-effects recovery and prevents complications:
reduces postop abdominal distension
prevents stasis of blood
pain often decreased, hospital stay shorter, less costly

52
Q

maintaining normal body temp…

A

at risk of malignant hyperthermia and hypothermia

  • identify it and treat early
  • comfy temp, blankets, O2, hydration, nutrition
53
Q

when is nasogastric tube inserted

A

preop if vomiting risk is high d/t surgery

also may be inserted before surgery if postop distension is anticipated

54
Q

hiccups and surgery

A

may be produced by intermittent spasms of diaphragm secondary to irritation of phrenic nerve may be indirect or indirect, if persist physician may prescribe nothiazine meds

55
Q

abdominal distension after surgery may be due to

A

accumulation of gas, further increased by immobility, anesthetics, and opioid meds
-can be avoided by getting pt to turn, exercise, ambulate early

56
Q

potential GI complication?

A

paralytic ileus and intestinal obstruction

57
Q

when is pt expected to void after surgery?

A

within 8 hrs after surgery—> methods encouraged to help pt void before catheterization (like letting water run, applying heat)

58
Q

bed position immediately after post up?

A

low, side railings up

59
Q

prophylactic treatment for DVT

A

heparin, warfarin

also can use pneumatic compression and antiembolism stockings

60
Q

first symptom of DVT?

A

pain or cramp in calf, initial pain and tender following swelling of entire leg

61
Q

hematoma management

A

physician will remove some suture and clot can be evacuated and wound is packed tighly

62
Q

wound infection may not be evident until

A

at least post op day 5! most pts are discharged at this time

63
Q

dehiscence of wound=

A

disruption of surgical incision or wound

64
Q

evisceration=

A

protrusion of wound contents

65
Q

earliest sign of wound infection may be:

A

gush of serosanguineous peritoneal fluid from wound

66
Q

what do you do if there is disruption to the wound?

A

place pt in low fowler position and instruct to lie quietly, cover protrusion coils of intestine w sterile dressings

67
Q

peds- continuous monitoring of _______ status is essential during immediate postop

A

cardiopulmonary status

68
Q

in susceptible children what triggers malignant hyperthermia?

A

inhaled anesthetics and muscle relaxant succinylcholine trigger the disorder, produce hypermetabolism

69
Q

symptoms of MH

A

hypercarbia, elevated temp, tachycardia, tachypnea, acidosis, muscle rigidity

70
Q

treatment of MH

A

immediate discontinuation of trigger, hyperventilation w oxygen, IV dantrolene sodium, cooling measures, transfer to CCU

71
Q

child needs to change position

A

every 2 hours

72
Q

most commonly used IV PCA opioid?

A

morphine

73
Q

patient safety to PCA?

A

numerous benefits, but processes around PCA can threaten safety
-errors include each phase of medication-use process (from prescribing, through transcribing, dispensing, administering, monitoring

74
Q

typical PCA order includes:

A

patient, allergy info, analgesic product to be used, initial loading (bolus) dose, basal rate, lock-out interval, duration

75
Q

nurses role in administering and monitoring PCA

A
  • review prescribers order, set the parameters (loading dose, lock-out interval, basal rate)
  • provide education
  • assess cognition of pt (ensure they can use it)
  • secure programmable device and specialized tubing
76
Q

nursing should be well versed in assessing patients whaaat for PCAs?

A

resp status!!! opioids

-common to use resp monitoring equipment when PCA is in use to increase safety

77
Q

treating an overdose of a PCA should be aimed at

A

establishing patent airway, and if necessary ventilatory support

78
Q

PCA by proxy? what is this

A

unauthorized person presses delivery button to deliver med to pt

  • increases risk of harm
  • nurses must educate pt and visitors, family, friends that the dangers of proxy !!

n233 final (11 decks)

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